The rising cost of health care has generated concern among many groups. These groups have different, and very often conflicting, interests in the health care that is provided. For example, many people who receive health care services would like to be given the best medical treatment available, regardless of the cost. In other words, these people are interested only in the quality of health care. On the other hand, groups which must pay for health care, such as insurance companies, would like to maximize the medical benefits provided for a given amount of money. That is, these payers are primarily interested in the utilization of health care resources.
Ultimately, both the quality and the utilization of resources in a health care system are determined by the physicians who provide the care. Physicians who provide health care of the highest quality for the least amount of cost will be sought by both the people who receive care and the groups which pay for care. Accordingly, the conflict of interests between these groups may be resolved by evaluating the performance of physicians. In particular, comprehensive, comparative analysis of physician performance would permit normal market forces to operate in the medical marketplace so that physicians who provide high quality care for low cost are rewarded.
Prior systems and methods attempted to use classical statistical methods for analyzing physician performance. However, these prior systems and methods were frustrated by the many dimensions of data which had to be analyzed.
To begin, the individual characteristics of a patient were multivariate. Because each member of a patient population had numerous individual characteristics, classical statistical methods were unable to define a reasonable standard of care that had to be followed for the average, or "core element," of the patient population. More specifically, the classical methods did not exclude the characteristics of special patients (outliers) who did not fall within the core element. For example, one patient may have been allergic to medication that could have been used to cure a particular ailment in 99% of the patient population. This patient required a treatment that was 1000 times more expensive than the medication used on the rest of the patient population. Even though this patient was clearly an outlier, classical statistical methods did not exclude the special treatment in defining a standard of care for the core element. Consequently, the standard of care defined by classical statistics was distorted.
Furthermore, the treatment of a particular ailment was multivariate. For any particular ailment, a standard of care as described above would define the proper treatment, the expected cost of treatment, and amount of risk expected in the treatment process. A physician who did not administer proper treatment, charged an abnormally high rate for the treatment, or exposed a patient to a greater amount of risk than necessary in treatment was considered to be performing outside of the standard of care. Although such a physician should have been identified by comparative analysis, classical statistical methods were often unable to do so.
Accordingly, a need has arisen for a system and method to accurately assess the comparative performance of a physician.